Provider Demographics
NPI:1821668351
Name:STOUDMIRE, BARBARA ANN (PMHNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:STOUDMIRE
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 NEW HAVEN RD
Mailing Address - Street 2:10F
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4776
Mailing Address - Country:US
Mailing Address - Phone:203-676-6594
Mailing Address - Fax:
Practice Address - Street 1:1081 NEW HAVEN RD
Practice Address - Street 2:10F
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4776
Practice Address - Country:US
Practice Address - Phone:203-676-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9758363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health